| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCHELLENBER MARK A3 | 416 MAIN ST STE 432 PEORIA, IL 616021141 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $156 | $0 | $156 | 2.02% |
| HENERSON JON ALAN3 | 6 PPG PL STE 600 PITTSBURG, PA 152225406 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.13% |
| HETTIGER JOHN STRATTON3 | 900 E 96TH ST INDIANAPOLIS, IN 46240 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $0 | $3 | $3 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ONEAMERICA RETIREMENT SERVICES, LLC EIN 46-5378846 NONE | Participant loan processing; Participant communication; Distribution (12b-1) fees; Recordkeeping fees; Shareholder servicing fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Copying and duplicating; Direct payment from the plan Service code 15 | — | $6K |
| BMO HARRIS BANK, NA EIN 36-2085229 NONE | Trustee (directed); Custodial (securities); Float revenue; Trustee (bank, trust company, or similar financial institution) Service code 19 | — | $0 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 227 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 49 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 277 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | 48 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 48 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.